Pediatric patients can suffer from excessive sweating

Dermatologists and primary-care physicians should recognize that hyperhidrosis is not limited to their adult patients, but that pediatric patients can also present with this condition that can greatly impair quality of life.

Adelaide A. Hebert M.D., professor of dermatology and pediatrics, University of  Texas Medical School, Houston, recently published a manuscript discussing special considerations in the management of hyperhidrosis in children. The paper noted that about 1.6 percent of adolescents and 0.6 percent of prepubertal children are affected by primary hyperhidrosis, and that children who experience the disease state often experience social distress. Dermatologic Clinics. 2014 Oct;32(4):477-484.

"The implications for children can be evidenced in daily activities," Dr. Hebert said in an interview with Dermatology Times. "Their hands may be sweating, and they cannot participate fully in games with other children. The affected children may not be able to hold a bat to play baseball or have other children agree to hold their hands when playing ring around the rosy."

Children who have plantar hyperhidrosis may not be able to wear footwear like flip-flops because their feet slip out of them. Additionally, hyperhidrosis sufferers have a hard time finding footwear that will not be ruined by the excessive sweating, explains Dr. Hebert.

Quality of life impact

"We need to bring attention to this medical condition and make dermatologists aware that it is a disease that can impact the quality of life of pediatric patients," says Dr. Hebert.

Typically, parents bring their children to a clinician to when they take note of the excessive sweating. Even when children do not tell their parents about their condition, they may research it themselves on the Internet and find out about their disease state on their own, notes Dr. Hebert.

A key resource for patients with hyperhidrosis, both adults and children, is a website called SweatHelp.org, which is sponsored by the International Hyperhidrosis Society. Of late, a website targeted specifically at teens has been introduced called sweatometer.org.

"They (children and adolescents) feel tremendous relief at finding empathy about what is happening to them," says Dr. Hebert. "Many young patients are relieved to find information via the website and to learn that they are far from alone in their challenges in managing their hyperhidrosis. As dermatologists, we can often offer strategies for them to manage this disease."

NEXT: Treatment options for kids

Treatment options

One of the most common therapies employed to treat pediatric patients with primary, focal hyperhidrosis is oral glycopyrrolate. Patients with hyperhidrosis must continue using their therapy such as glycopyrrolate because the excessive sweating will return on cessation of the medication, stresses Dr. Hebert.

"My pediatric hyperhidrosis patients tell me that they do not want to go even one or two days without their medication because they will promptly begin sweating again," says Dr. Hebert. "The hyperhidrosis will come back in a day or two if they have not been compliant with the medical regimen. In contrast, acne patients who do adhere to their acne medication for a day or two do not experience  an immediate return to pre-treatment levels of acne."

There may be some undesirable side effects with therapies like glycopyrrolate such as constipation or dry mouth, notes Dr. Hebert.

Another option for children with plantar and/or palmar hyperhidrosis is iontophoresis, where patients are exposed to a low level and well-tolerated electrical current that lessens the sweating of the palms and soles. If children have severe plantar and/or palmar hyperhidrosis, an option for management is to drop glycopyrrolate tablets in the iontophoresis trays to increase the robustness of therapy, explains Dr. Hebert.

If hyperhidrosis is not well-controlled in pediatric patients with therapies like oral anticholinergics or with iontophoresis, clinician may look to botulinum toxin injections to manage the condition, says Dr. Hebert. Such therapy is considered off label.

Newer treatments such as miraDry, which uses non-invasive microwave technology, was approved by the US Food and Drug Administration in 2011 to treat hyperhidrosis. The device, however, has not been studied in the pediatric population, says Dr. Hebert.

The disease remains idiopathic, but research into hyperhidrosis may lead to newer treatments in the future that target the cause of the condition, says Dr. Hebert.

"We are getting better at understanding the causation of many disease states," says Dr. Hebert. "Many people are looking at why there is central nervous system dysfunction in hyperhidrosis patients. The arena of the autonomic nervous system is more in the purview of the neurologist than the dermatologist."

The neuromodulating agent botulinum toxin, a treatment which is very commonly used to treat axillary hyperhidrosis, works on the pre-synaptic receptors, notes Dr. Hebert.

The long-term impact of untreated hyperhidrosis is the threat of a limited social life and isolation, says Dr. Hebert. "Some patients may choose not even attending family outings because of their condition," she says.

All dermatologists should be aware of the potential to diagnose hyperhidrosis in pediatric patients and offer therapeutic interventions to reduce the burden of the disease state and ultimately increase the patient's quality of life, stresses Dr. Hebert.  "Even children suffering with hyperhidrosis during childhood deserve to have a happy and socially fulfilling life," she says.

Dr. Hebert had no relevant disclosures.